Physician Bill Review
MMR has developed an integrated approach to determining reimbursement values using a combination of state mandated work related fee schedules (where applicable, or where the provider will accept it), the use of UCR (Usual, Customary & Reasonable) tables, comparable payments for the services rendered (our own proprietary statistical database) and the use of PPO’s (Preferred Provider Organizations).
It is our mission to obtain the largest possible discount on a provider’s billing as is possible. We maintain the approach is that almost ALL bills can be reduced in order to save our clients on their medical costs. Our procedure is designed to ensure every recommended allowance is accurate. We do the following:
- Contact every provider to determine whether or not the service was provided on the date listed on the bill;
- Review for possible duplication of billing (our systems maintain the history of all medical bills entered for a specific injury/claim. Thus avoiding erroneous payments to providers;
- The service was billed at the correct service level (ie: long, medium or short office visit);
- Review any and all reports that are provided;
- Determine if there has been an Unbundling of services using CCI (Correct Coding Initiative) edits to ensure there are NO over-payments;
- Determine what the correct CPT codes (Current Procedural Terminology) should be for the service performed and ensure that the submitted provider billing is in compliance with the practices and guidelines as established by the CPT;
- Review all Drug & Supply Charges based upon the regulations that may be applied in the provider’s area OR that can be negotiated;
- Make a recommended allowance to our client and issue an Explanation of Review to accompany the payment; AND
- GUARANTEE that the amount is correct OR we pay the difference.
It is through this approach that MMR is able to achieve the highest discounts off the provider’s billed charges as possible. Our recommended allowances will average between 35% and 50% below the charges for a large majority of physician bills.
The BENEFITS of the MMR systematic approach are obvious:
- We provide easy to use, defensible Explanations of Review – THAT ARE GUARANTEED !
- Rapid Turn Around Time – 24 to 48 hours in most cases;
- We work in ALL 50 states;
- Our systems are in compliance with any regulatory statutes where they may be applicable;
- Our recommended allowances provide fair and reasonable payments for the medical services provided.